What is a rotator cuff injury?
It’s a type of shoulder injury to the rotator cuff. The rotator cuff is a group of four muscles and tendons around the shoulder joint. These muscles keep the head of your upper arm bone firmly in the shallow socket of your shoulder. They support your shoulder and help it move.
Rotator cuff injury is common. Your risk is higher as you get older and if your work involves repeated overhead movements eg painting. Usually symptoms can be managed at home. You may need to perform different exercises (excluding overhead movements) and have physiotherapy to regain your full range of movement. Painkillers and steroid injections may also be needed. Surgery may be an option. Some rotator cuff tears are caused by a single injury, which can be repaired with surgery.
Types of rotator cuff injury
There are different types of rotator cuff injury. The main ones are listed below.
- Rotator cuff tear. This is when one or more of the muscles and tendons that make up your rotator cuff tears. You can have a partial or a full tear. A tear can happen suddenly, after a single injury. Or, it can develop gradually, over time.
- Tendinopathy. This term covers many different conditions affecting the tendons around your shoulder. Some of the tendons can become trapped between a bone at the top of your arm and the top of your shoulder blade. This is called subacromial or shoulder impingement. The tendon can eventually tear over time.
Causes of rotator cuff injuries
Most rotator cuff injuries develop slowly, over time.
You’re also more likely to develop a rotator cuff injury if you do a lot of repeated overhead movements. This includes activities, such as throwing, painting, lifting weights and swimming front crawl.
You can also get a tear in your rotator cuff if you have a sudden (acute) injury to your shoulder. This might include a fall or other accident.
What does the rotator cuff do?
The rotator cuff stabilises your shoulder joint and helps your shoulder move. Each of its four muscles is attached to a tendon; these four tendons join together to form one large tendon called the rotator cuff tendon. This tendon attaches to the head of the humerus.
The rotator cuff tendon passes through a space under the acromion part of the scapula called the subacromial space. This space contains fluid-filled sacs (bursae), which have many pain sensors.
Symptoms of rotator cuff injuries
Symptoms of a rotator cuff injury include:
- Intense pain when you raise your arm above your shoulder eg when combing your hair, dressing or performing activities such as basketball, painting and swimming — you may feel a catching or clicking when you move your shoulder, but writing and typing may not cause much or any pain
- Pain in and around your shoulder joint
- Pain may be long-term (chronic), which sometimes gets worse at night, or acute eg a sudden tearing sensation
- Reduced movement in your shoulder
- Weakness in your shoulder and arm
- Clicking or grating sound when you move your shoulder
- If you experience shoulder pain along with other symptoms, such as chest pain or tightness or shortness of breath, then seek immediate medical help.
Diagnosis of rotator cuff injuries
Your physiotherapist will usually be able to diagnose rotator cuff injury by asking about your symptoms and examining you.
Sometimes your physiotherapist may need to refer you to a Specialist. A specialist might recommend taking images of your shoulder to get a better look at the damage, and plan your treatment. Imaging tests they may recommend include:
- a shoulder X-ray
- an MRI scan
- an ultrasound scan
Self-help
Your Physiotherapist may advise a period of resting your shoulder first. Try not to lift heavy weights or do activities that involve lifting your arm over your head. You can gradually start to increase the activity you do when your shoulder starts to feel better.
You might find it helps to use an ice pack to help relieve pain. Wrap the ice pack in a towel or dishcloth before using it. Never put an ice pack directly on to your skin as it may cause damage or give you a burn.
If you need pain relief, you can take over the counter pain killers, such as paracetamol or ibuprofen. Your doctor or pharmacist may recommend certain other painkillers.
Physiotherapy
A Physiotherapist will show you some rotator cuff stretches and exercises you can do at home to help improve the strength and movement of your shoulder. The exact exercises you’ll need to do will depend on the type of injury you have. You may continue having physiotherapy sessions for up to six weeks. Many people make a good recovery within this time.
Steroid injection
If your shoulder pain is still severe despite trying the measures above, your doctor may offer you a steroid injection. A steroid injection can help to reduce swelling and pain in your shoulder. This may reduce your symptoms enough to be able to continue with physiotherapy exercises. However, steroid injections can have side-effects. Your doctor will help you to weigh up the risks and benefits of having one.
Surgery
Your doctor may suggest surgery as an option if you have a rotator cuff tear caused by a sudden injury. They may also suggest surgery if you have a long-term injury and other treatments haven’t helped.